Radiation Oncology Setting Research Articles

A Qualitative Exploration of Sacred Moments in Radiation Oncology

PURPOSEWhile there are many benefits to radiation oncology services, there can be emotional burdens in the care of patients with advanced cancer. Burnout is a prevalent problem in oncology. Existing literature suggests re-focusing attention on providers’ sense of purpose to protect against burnout. “Sacred moments” are moments of deep interconnection between people with accompanying spiritual emotions such as awe, joy, and gratitude. These moments naturally occur in healthcare settings, offering potential benefits to both patient and provider. Little is known about the prevalence and impact of sacred moments among healthcare workers in a radiation oncology setting. METHODS AND MATERIALSWe conducted an exploratory qualitative study of 13 semi-structured interviews among physicians, registered nurses, and advanced practice providers of a radiation oncology consult service at a large National Cancer Institute-designated cancer center between March and April 2023. Interviews were recorded, transcribed, and analyzed to identify key themes. Data were systematically coded and analyzed in NVivo software, and organized into a codebook organized by domains and themes. RESULTSOf the 13 healthcare workers interviewed, 12 people reported experiencing at least one sacred moment during their clinical careers. None of the interviewees were initially familiar with the term; however, all understood the concept once explained. Interview findings were organized into four domains: (1) Common Elements, (2) Impact, (3) Barriers, and (4) Provider Reactions. Common elements included a moment of deep interconnection between provider and patient, often involving end-of-life patients. The impact of these moments was most commonly described as an increased sense of purpose in their role. Lack of time with patients was the most common barrier. CONCLUSIONSSacred moments are commonly experienced by healthcare workers in a radiation oncology consult service. They helped to humanize the patient, buffer against provider burnout, and increase a sense of purpose and job satisfaction.

Development and psychometric validation of a patient safety assessment tool in German Radiation Oncology: the PaSaGeRO Study protocol

IntroductionEnsuring patient safety in radiation oncology is crucial for delivering high-quality healthcare. Patient safety indicators (PSIs) provide a mechanism for identifying, quantifying and evaluating risks and the effectiveness of safety...

Investigating the Needs and Concerns of Lesbian, Gay, Bisexual, Transgender, Queer, or Questioning Cancer Patients

ABSTRACT The needs and concerns of lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) patients with cancer remain poorly understood. This is important as LGBTQ+ patients have an elevated risk of developing certain cancers and have poorer oncologic outcomes compared to non-LGBTQ+ patients. The lack of research may be linked to the complexity of studying the needs and concerns of this patient population. This review aimed to describe the evidence that sought to identify the needs and concerns of LGBTQ+ cancer patients. Studies were extracted using keywords such as “LGBTQ” and “Oncology.” Patient participants were excluded if they did not identify as LGBTQ+ and if they did not have cancer or were not cancer survivors. Healthcare professionals were excluded if they were not oncology specific. A total of 22 studies met our inclusion criteria. LGBTQ+ cancer patients expressed concerns surrounding heteronormative assumptions made by healthcare professionals, a lack of LGBTQ±specific cancer support groups, and psychosexual concerns such as erectile dysfunction following cancer treatment. Oncology healthcare professionals lacked the knowledge and education that are required to manage this patient cohort. Further research is required to investigate the needs and concerns of LGBTQ+ cancer patients specifically in the radiation oncology setting.

A single-institution experience with 177Lu RPT workflow improvements and qualifying the SPECT/CT imaging for dosimetry.

Implementing any radiopharmaceutical therapy (RPT) program requires a comprehensive review of system readiness, appropriate workflows, and training to ensure safe and efficient treatment delivery. A quantitative assessment of the dose delivered to targets and organs at risk (OAR) using RPT is possible by correlating the absorbed doses with the delivered radioactivity. Integrating dosimetry into an established RPT program demands a thorough analysis of the necessary components and system fine-tuning. This study aims to report an optimized workflow for molecular radiation therapy using 177Lu with a primary focus on integrating patient-specific dosimetry into an established radiopharmaceutical program in a radiation oncology setting. We comprehensively reviewed using the Plan-Do-Check-Act (PDCA) cycle, including efficacy and accuracy of delivery and all aspects of radiation safety of the RPT program. The GE Discovery SPECT/CT 670DR™ system was calibrated per MIM protocol for dose calculation on MIM SurePlan™ MRT software. Jaszcak Phantom with 15-20 mCi of 177Lu DOTATATE with 2.5 µM EDTA solution was used, with the main energy window defined as 208 keV ±10% (187.6 to 229.2 keV); the upper scatter energy window was set to 240 keV ±5% (228 to 252 keV), while the lower scatter energy window was 177.8 keV ±5% (168.9 to 186.7 keV). Volumetric quality control tests and adjustments were performed to ensure the correct alignment of the table, NM, and CT gantry on SPECT/CT. A comprehensive end-to-end (E2E) test was performed to ensure workflow, functionality, and quantitative dose accuracy. Workflow improvements and checklists are presented after systematically analyzing over 400 administrations of 177Lu-based RPT. Injected activity to each sphere in the NEMA Phantom scan was quantified, and the MIM Sureplan MRT reconstruction images calculated activities within ±12% of the injected activity. Image alignment tests on the SPECT/CT showed a discrepancy of more than the maximum tolerance of 2.2 mm on any individual axis. As a result of servicing the machine and updating the VQC and COR corrections, the hybrid imaging system was adjusted to achieve an accuracy of <1 mm in all directions. Workflows and checklists, after analysis of system readiness and adequate training for staff and patients, are presented. Hardware and software components for patient-specific dosimetry are presented with a focus on hybrid image registration and correcting any errors that affect dosimetric quantification calculation. Moreover, this manuscript briefly overviews the necessary quality assurance requirements for converting diagnostic images into dosimetry measurement tools and integrating dosimetry for RPT based on 177Lu.

Interventions to Promote Safety Culture in Cancer Care: A Systematic Review.

There is limited guidance on how to effectively promote safety culture in health care settings. We performed a systematic review to identify interventions to promote safety culture, specifically in oncology settings. Medical Subject Headings and text words for "safety culture" and "cancer care" were combined to conduct structured searches of MEDLINE, EMBASE, CDSR, CINAHL, Cochrane CENTRAL, PsycINFO, Scopus, and Web of Science for peer-reviewed articles published from 1999 to 2021. To be included, articles had to evaluate a safety culture intervention in an oncology setting using a randomized or nonrandomized, pre-post (controlled or uncontrolled), interrupted time series, or repeated-measures study design. The review followed PRISMA guidelines; quality of included citations was assessed using the ROBINS-I risk of bias tool. Eighteen articles meeting the inclusion criteria were retained, reporting on interventions in radiation (14 of 18), medical (3 of 18), or general oncology (1 of 18) settings. Articles most commonly addressed incident learning systems (7 of 18), lean initiatives (4 of 18), or quality improvement programs (3 of 18). Although 72% of studies reported improvement in safety culture, there was substantial heterogeneity in the evaluation approach; rates of reporting of adverse events (9 of 18) or Agency for Healthcare Research and Quality Safety Culture survey results (9 of 18) were the most commonly used metrics. Most of the studies had moderate (28%) or severe (67%) risk of bias. Despite a growing evidence base describing interventions to promote safety culture in cancer care, definitive recommendations were difficult to make because of heterogeneity in study designs and outcomes. Implementation of incident learning systems seems to hold most promise.

Are Psychiatric Comorbidities in the Radiation Oncology Patient Population Under-Recognized by Providers?

Under-recognition of psychiatric comorbidities may be directly tied to potential for poorer patient outcomes. However, there is a paucity of data in radiation oncology settings. This study hypothesized that a disparity exists between the perceived prevalence of psychiatric comorbidities in patients receiving radiotherapy and the rate at which radiation oncologists screen patients for anxiety and depression. From April-July 2021 an online survey was conducted of radiation oncologist members of ASTRO with self-identified practice specializations. Randomly selected invitations were electronically sent to providers from diverse practice backgrounds and geographic locations within the United States and Canada and was conducted using an IRB-reviewed, institutionally approved Microsoft Forms platform. The questionnaire consisted of 20 items examining a broad range of factors that involved general practice demographics, patient screening practice patterns, treatment details and preferred options, and availability and referral data for specialist care for possible psychiatric comorbidities. Statistical analysis was performed using Fisher's exact test. For questions with Yes/No responses, exact binomial test was used. A total of 500online invitations were emailed with 55 responses. Of the responders, 3 did not provide consent. Therefore, 52 (10.4%) responses were included in the analysis and are the subject of this report. This response rate is consistent with other published studies of this type. 85% (p<0.001) of respondents identified the need to screen for psychiatric comorbidities in radiation oncology settings. However, 71% (p = 0.003) did not perform formal screening for psychiatric comorbidities, and of those who did screen, there was no uniformity in the screening tool utilized. Likewise, 79% (p<0.001) did not initiate treatment for psychiatric condition(s). Of providers that did initiate treatment, 91% (p = 0.012) felt that psychiatric comorbidities were under-diagnosed in their patient population. No association was made between providers who specialize in CNS malignancies as being more likely to recognize psychiatric comorbidities in their patient population versus those who do not. Importantly, 75% self-reported that they would benefit from additional training to assess psychiatric comorbidities (p<0.001). A need to screen for psychiatric comorbidities in radiation oncology settings was identified despite very little formal screening performed. Responses revealed adequate community resources exist for referral in most instances. However, providers did not routinely refer patients for treatment of psychiatric comorbidities, even when recognized. This survey identified an unmet need for improved education among providers to engage in screening and referral for psychiatric comorbidities, and to develop a care system that supports standardization of screening practices and tools in this patient population.

Identifying Key Barriers for Radiation Oncology Financial Advocacy Programs

Financial toxicity is a devastating outcome for patients with cancer and can impact their treatment adherence and health outcomes. One survey reveals that most radiation oncologists are "very concerned" with the negative impact treatment-related costs have on patients, and another survey found that more than 20 percent of patients experience financial toxicity related to their radiation therapy treatment. Financial advocates within cancer programs and practices can help mitigate patients' financial toxicity by supporting shared decision-making and helping with treatment cost planning. In 2022, ACCC set out to explore how financial advocates in radiation oncology provide financial navigation to patients with cancer and address the challenges they may face. Identify barriers to financial toxicity mitigation and treatment access challenges for patients with cancer undergoing radiation therapy. ACCC worked with an expert multidisciplinary Financial Advocacy Network Advisory Committee to conduct two, semi-structured discussion sessions on financial advocacy in radiation oncology. Prepared discussion topics included challenges and opportunities in delivering financial advocacy services, financial barriers to care and strategies to mitigate financial toxicity, and processes for prior authorizations and claim denials in the radiation oncology setting. Twenty-one participants attended the first session, and 17 participants attended the second session. Participants included financial navigators and counselors, oncology social workers, nurse navigators, and cancer program or practice administrators. Three major challenges emerged from both sessions: (1) Inadequate financial assistance from independent, charitable foundations to help pay for patients' deductibles, additional radiation treatment out-of-pocket costs, and care-related transportation costs. (2) Lack of best practices to handle prior authorization and avoid denials. (3) Lack of preparedness for changes imposed by the Radiation Oncology (RO) Model, which would impact care planning. Many cancer programs and practices have implemented financial advocacy services but remain restricted in the available assistance for radiation therapy patients. Radiation therapy represents a significant component of anti-cancer treatment and addressing the lack of financial support for patients is critical to improving patients' treatment adherence and health outcomes. Payment policies must be reformed to address complex prior authorization requirements and patients would benefit from greater financial support for radiation treatment and costs of wrap-around supportive services.

Identifying radiation therapists’ perceptions of potentially triggering aspects of care for survivors of sexual violence undergoing radiotherapy

IntroductionResearch shows that for survivors of sexual violence (SV), cancer procedures can be retraumatizing due to perceived similarities to the original SV. To date, there is no training program designed specifically for the radiation therapist (RTT) on how to deliver care sensitively to survivors of SV. A key component of sensitive practice is working with patients to identify and develop strategies to manage situations that could be triggering. The goal of this study was to understand the RTT recognition of potential sensory/environmental, relational, and mixed triggers in radiation oncology settings. MethodsThis quantitative research study conducted a secondary analysis on RTT responses to a learning activity from an online cancer education training program. The first section of the activity asked trainees to identify two potential triggers in a brachytherapy video, and the second portion of the activity asked trainees to describe two potential triggers in their own work. ResultsDescriptive statistics, χ2 tests, and t tests were used to analyze 50 RTT responses. RTTs tended to identify different types of triggers depending on the question (brachytherapy video vs. self-reflection). Data indicated that despite a lack of formal didactic training in trigger management, RTTs could identify triggers, and were most likely to recognize “mixed” type triggers. DiscussionTriggers identified are consistent with past research on childhood sexual abuse survivors’ healthcare retraumatization in obstetrics and gynecology, and cancer care. As in past research, invasive techniques, and situations where the patient was in a submissive position were identified as triggering aspects of care. It is interesting to note when reflecting on their own practice, the least identified triggers all fell under the environmental/sensory trigger category. RTTs may not fully appreciate a variety of potential triggers such as sounds of treatment or silence because they are outside of the room administering the beam when the machine is delivering treatment. Thus, they may not hear certain sounds or silence during their daily routine. ConclusionsRelatively few trainees identified sensory/ environmental triggers (e.g., restricted visibility and sounds of treatment, including silence) when reflecting on their own practice, which could potentially reduce their likelihood of helping patients minimize the impact of (or avoid) such triggers. Future research should identify a comprehensive list of triggers and then develop a training specific to the RTT focused on identifying environmental/sensory triggers from the perspective of the patient in the often unfamiliar and frightening radiotherapy suite.

4DCT is long overdue for improvement.

4DCT is long overdue for improvement.

The impact of telehealth on nursing care in the radiation oncology setting during the COVID-19 pandemic

ObjectiveThis article aims to explore care patterns and understand the impact of telehealth on nursing care in the radiation oncology setting at a comprehensive cancer center during the COVID-19 pandemic. MethodsFocus group interviews of radiation oncology nurses (n ​= ​18) were used to obtain data and describe current patient care patterns during the study period. Interviews were conducted over Zoom video conference, and content was analyzed. ResultsThree major themes were determined: (1) the evolution of nurses' roles during the transition to telehealth, (2) the resilience of the human element, and (3) the benefits and constraints of the institution's infrastructure. ConclusionsStudy results support radiation oncology nurses' ability to provide quality patient care using telehealth and can guide the expansion future care models for radiation oncology patients. Research exploring telehealth care outcomes among radiation patients is warranted. Radiation oncology nurses’ training and scope of practice must be expanded to include telehealth care. As telehealth care models continue to develop, there will be a need to address training and technical disparities among certain patient demographics.

Patient Perceptions of Sexual Orientation and Gender Identity Data Collection in an Outpatient Radiation Oncology Setting

Sexual and gender minority patients with cancer experience significant health disparities requiring tailored care. Collecting sexual orientation and gender identity (SOGI) data in the electronic medical record (EMR) could allow care to be tailored and is in line with radiation oncology's mission to better serve diverse patients. This article describes a systematic method for collecting SOGI data for all patients starting radiation treatment in a department of radiation oncology (DRO). During a 3-month experimental period, DRO staff administered a demographic questionnaire and attitude survey to new adult patients. SOGI demographic data, entered into the EMR by nursing staff, were extracted and analyzed for all patients from the experimental period and from the 3 months prior (control period). Descriptive and categorical data completion rates were compared between the experimental and control periods using independent-samples t tests and Pearson χ2 tests. A total of 788 patients were included in this analysis: 368 in the control period and 420 in the experimental period. Of the 420 patients enrolled in the experimental period, 267 (63.6%) were offered a survey, of whom 211 (79.0%) completed the survey. There were higher rates of sexual orientation responses entered into the EMR for the experimental group compared with the control group (56.9% vs 27.1%; P <.001), with the highest response rates for patients who completed a survey (82.9%). Ten patients (2.9%) identified as gay or lesbian and 100% identified as cisgender. The majority of patients were not upset by the form, with only 11 patients (5.2%) stating that any specific question caused them distress. Collecting SOGI data via a demographic form is feasible in an outpatient DRO. This approach was well received by the majority of patients and could lead to provision of higher-quality, tailored care.

Investigating the Incidence of Pulmonary Abnormalities as Identified by Parametric Response Mapping in Patients With Lung Cancer Before Radiation Treatment

PurposeParametric response mapping (PRM) of high-resolution, paired inspiration and expiration computed tomography (CT) scans is a promising analytical imaging technique that is currently used in diagnostic applications and offers the ability to characterize and quantify certain pulmonary pathologies on a patient-specific basis. As one of the first studies to implement such a technique in the radiation oncology clinic, the goal of this work was to assess the feasibility for PRM analysis to identify pulmonary abnormalities in patients with lung cancer before radiation therapy (RT). Methods and MaterialsHigh-resolution, paired inspiration and expiration CT scans were acquired from 23 patients with lung cancer as part of routine treatment planning CT acquisition. When applied to the paired CT scans, PRM analysis classifies lung parenchyma, on a voxel-wise basis, as normal, small airways disease (SAD), emphysema, or parenchymal disease (PD). PRM classifications were quantified as a percent of total lung volume and were evaluated globally and regionally within the lung. ResultsPRM analysis of pre-RT CT scans was successfully implemented using a workflow that produced patient-specific maps and quantified specific phenotypes of pulmonary abnormalities. Through this study, a large prevalence of SAD and PD was demonstrated in this lung cancer patient population, with global averages of 10% and 17%, respectively. Moreover, PRM-classified normal and SAD in the region with primary tumor involvement were found to be significantly different from global lung values. When present, elevated levels of PD and SAD abnormalities tended to be pervasive in multiple regions of the lung, indicating a large burden of underlying disease. ConclusionsPulmonary abnormalities, as detected by PRM, were characterized in patients with lung cancer scheduled for RT. Although further study is needed, PRM is a highly accessible CT-based imaging technique that has the potential to identify local lung abnormalities associated with chronic obstructive pulmonary disease and interstitial lung disease. Further investigation in the radiation oncology setting may provide strategies for tailoring RT planning and risk assessment based on pre-existing PRM-based pathology.

Competency-Based Medical Education in Canadian Radiation Oncology Residency Training: an Institutional Implementation Pilot Study.

Canadian radiation oncology (RO) residency programs transitioned to a competency-based medical education (CBME) training model named Competence by Design (CBD) in July 2019. Prior to this, CBD was piloted in a single RO training program to characterize assessment completion and challenges of implementation. Six residents and seven staff participated in a mixed-methods study and were oriented to CBD. Four Entrustable Professional Activities were assessed over a 4-week-long block and documented using online assessment forms. Anonymized assessments were analyzed to characterize completion. Post-pilot surveys were completed by 4/6 residents and 5/7 staff. Semi-structured post-pilot focus groups were conducted with all residents. Assessments were requested and documented on a weekly basis. Narrative comments were found in 68.1% of assessments, of which 26.7% described specific examples of observed competence or recommendations for improvement. Three of five staff believed that assessments have a negative impact on clinical workflow. Three themes were identified: (1) direct observation is the most challenging aspect of CBD to implement; (2) feedback content can be improved; and (3) staff attitude, clinical workflow, and inaccessibility of assessment forms are the primary barriers to completing assessments. This study demonstrates that CBD assessments can be completed regularly in an outpatient radiation oncology setting and that implementation challenges include improving feedback quality, promoting direct observation, and continuing faculty development to improve perceptions of this assessment model. Further study is required to identify best practices and expectations for the discipline in the era of CBME.

The Impact of Interpersonal Skills Training on the Transition to Radiotherapy Student Clerkship

Preparing students for clerkship in a radiation oncology setting requires complex, sensitive, and specific interpersonal skills training. Oncology patients undergoing radiation therapy treatment present with unique needs given the harrow of a cancer diagnosis. Although the radiation therapy profession's credentialing body requires interpersonal skills training, there is little research specific to radiotherapy student communication training across the globe. Searches for relevant literature were conducted and the following themes emerged: transitions to clinical training, value of interpersonal skills and value of interprofessional education. The majority of literature identified supported medical, nursing, physical therapy and physician's assistant education. Radiotherapy students often participate in the same undergraduate coursework with various health science disciplines, with a common goal of providing optimal patient care. This diverse classroom of radiation therapy, radiologic technology, and dosimetry students mimic the interdisciplinary team in radiation oncology, preparing students for clerkship in a safe and authentic environment. Interprofessional education serves as a vehicle to enhance the transition from the classroom to the clinic while simulating the alliance of healthcare professionals required for team-based care. Interpersonal skills training specific to radiation therapy education is lacking and further limited to research conducted in Canada, New Zealand, and Australia. The gap in research in the United States provides many areas of opportunity.

Prognostic tools for survival prediction in advanced cancer patients: A systematic review

Survival prediction for palliative cancer patients by physicians is often optimistic. Patients with a very short life expectancy (<4weeks) may not benefit from radiation therapy (RT), as the time to maximal symptom relief after treatment can take 4-6weeks. We aimed to identify a prognostic tool (or tools) to predict survival of less than 4weeks and less than 3months in patients with advanced cancer to guide the choice of radiation dose and fractionation. We searched Embase, Medline (EBSCOhost) and CINAHL (EBSCOhost) clinical databases for literature published between January 2008 and June 2018. Seventeen studies met the inclusion criteria and were included in the review. Prediction accuracy at less than 4weeks and less than 3months were compared across the prognostic tools. Reporting of prediction accuracy among the different studies was not consistent: the Palliative Prognostic Score (PaP), Palliative Prognostic Index (PPI) and Number of Risk Factors (NRF) best-predicted survival duration of less than 4weeks. The PPI, performance status with Palliative Prognostic Index (PS-PPI), NRF and Survival Prediction Score (SPS) may predict 3-month survival. We recommend PPI and PaP tools to assess the likelihood of a patient surviving less than 4weeks. If predicted to survive longer and RT is justified, the NRF tool could be used to determine survival probability less than 3months which can then help clinicians select dose and fractionation. Future research is needed to verify the reliability of survival prediction using these prognostic tools in a radiation oncology setting.

How do radiation therapists detect and manage patients experiencing anxiety in the radiation oncology setting? A vignette study.

Anxiety is commonly observed in oncology patients but infrequently screened, assessed or addressed. According to psychosocial guidelines, all healthcare professionals, including radiation therapists, are responsible for the psychosocial care of patients. Radiation therapists (RTs) interact with patients daily throughout treatment; however, little research exists to evaluate RTs' ability to identify and manage patients' psychosocial needs. This study aimed to determine if RTs can detect and manage patient anxiety. A cross-sectional, mixed-methods survey containing two clinically relevant vignettes was developed. Two fictitious patients were presented to elicit responses reflective of RTs' experiences and judgements in the recognition and management of anxiety. Surveys were distributed via email in Australia, New Zealand and Canada. Ethical approval was obtained from the University of Sydney (2016/227) and informed consent was obtained from participants. Eligible and complete surveys were received from 582 respondents (240 (41.2%) from Australia; 78 (13.4%) New Zealand; 264 (45.4%) Canada). Almost all respondents endorsed a relevant descriptor of anxiety (vignette 1, 577 (99.1%); vignette 2, 579 (99.5%)). For both vignettes, the most frequently endorsed management strategy was to acknowledge the patients' feelings and encourage them to express their concerns (vignette 1, 548 (94.2%); vignette 2, 455 (78.2%)). RTs in Australia, New Zealand and Canada are able to detect anxiety and endorse a strategy to manage patients experiencing anxiety depicted in written vignettes. Exploring RTs' abilities to detect and manage patient anxiety whilst in the high-pressure clinical environment is an important next step.

Emergency Response Preparation in a New Outpatient Proton Center

Patient acuity is increasing in the ambulatory setting. New treatments and techniques assist patients in living longer, in turn allowing additional comorbidities to develop. Many of these comorbidities may require urgent treatment. Emergency response preparation can have a positive impact on readiness and timed responses to prevent and respond to emergencies. A new 80,000 square-foot ambulatory proton center was built within an academically-aligned community hospital. As part of its opening, protocols for emergency response preparation were developed and enacted. The aim of this Quality Improvement project was to develop a plan for emergency response as it pertains to declining patients and medical codes in a newly-opened ambulatory radiation oncology setting. Emergency response plans were developed in collaboration with the Armstrong Institute using the Systems Engineering Initiative for Patient Safety model (SEIPS) model to guide practice. The SEIPS model provides guidance when analyzing factors that affect patient safety. The focus of the plan was to identify potential risks and mitigate them in order to minimize adverse safety events for patients. Additionally, the plan was designed to allow for process improvement to improve quality and patient outcomes. The response plan was tested with three simulated scenarios: rapid response to a patient fall, pediatric cardiac arrest, and a medical emergency during an MRI procedure. Due to the scope of the exercise, only the pediatric cardiac arrest was trialed more than once. For the patient fall scenario, a hospital wide alert was dispatched in 25 seconds for the response team. The first rapid responder arrived within 85 seconds and the stretcher was brought to the scene in an additional 90 seconds. During the MRI scenario, staff were able to reduce the time to move the patient from 64 to 42 seconds. In the pediatric cardiac arrest scenario, there were decreases in time for staff arrival, arrival of an emergency cart, defibrillation, stretcher arrival, and transport to an appropriate level of care. Overall practice gaps identified include issues with the automated communications, and the need for ergonomic techniques for moving heavy equipment, an MRI stretcher, lighting in stairwells, and badge access. This quality improvement project utilized scenarios to facilitate identification of gaps in practice. Common themes amongst the scenarios were identified, and team members from various disciplines were able to work together to identify solutions to close the gaps. When opening a new outpatient clinical site, it is important to identify and test emergency response plans in order to promote patient safety.

An Assessment of Technology Usage and Barriers to Adoption Among Patients in a Radiation Oncology Clinic

Mobile and digital technology may provide platforms for consistent and real-time symptom tracking for cancer patients, allowing for improvements in symptom reporting and timely interventions. There has been limited research about barriers to adoption within the oncology setting. Understanding patients’ perceptions, concerns, and willingness to adopt these tools is key for development and successful implementation. To determine technology usage and willingness among patients to utilize mobile technologies to report symptoms in an outpatient radiation oncology setting. Adult patients completed an anonymized survey consisting of 21 questions. Demographics, technology usage, barriers to utilization, and willingness to report data were studied using descriptive statistics. These were compared using chi-square tests for categorical variables, with a statistical significance of p<0.05. Predictors of willingness to use mobile applications to report symptoms were analyzed using univariate and multivariate logistic regression. 144 patients completed the survey, with mean age 64 years, 70% Caucasian, and 50% male. Of the cohort, 66.7% used a smartphone, 87.5% reported access to home internet, and 79.2% used a computer. Only 17% of patients reported using a wearable fitness tracker. Concern for privacy (26.0%) and limited technological literacy (18.8%) were identified as significant barriers to reporting health-related data via mobile applications. 69% would be willing to use a mobile application to record/report cancer symptoms. Age >65 (OR 0.27), owning a smartphone (OR 3.60, p=0.001), not owning a computer (OR 0.35), concern for privacy (OR 0.35), and limited technological literacy (OR 0.38) were identified on univariate analysis as significant variables (P<0.05) affecting participants’ willingness to report health-related data via a mobile application. On multivariate analysis, only age >65 (OR 0.29) and owning a smartphone (OR 4.27) were significantly associated with willingness to report symptoms via a mobile application. By age distribution, the percentage of patients reporting willingness at <50yrs, 50-59yrs, 60-69 yrs, ≥ 70yrs were 93%, 77%, 71%, and 55% respectively (p=0.035). Compared to those age <50yrs, those age ≥70yrs were 10 times less likely to be willing to use a device to report symptoms (OR 0.10, P=0.029). The majority of radiation oncology patients are willing to use mobile technology to report symptoms, with willingness increasing with younger age and smartphone ownership. While care should be taken to address patient privacy and technological literacy concerns, future efforts in developing and testing mobile applications for reporting cancer symptoms in this population is warranted while addressing barriers to adoption.

Safety culture interventions in cancer care: A systematic review.

247 Background: Creation of a culture of safety in healthcare organizations is fundamentally important to patient safety. However, there is limited guidance on how to effectively promote a culture of safety in healthcare settings including in oncology. We performed a systematic review to identify interventions or strategies to promote safety culture in cancer care. Methods: Medical Subject Headings and text words for “safety culture” and “cancer care” were combined to conduct structured searches in MEDLINE, EMBASE, CDSR, CINAHL, Cochrane CENTRAL, Epub Ahead of Print &amp; In-Process, PsycINFO, Scopus, and Web of Science databases, for peer-reviewed articles published between 1999 and 2017. Articles were included if they described an intervention or strategy to promote safety culture in an oncology setting, and quantitative outcomes were reported. Study quality was assessed using the ROBINS-I risk of bias tool. Results: We screened 21,572 studies, of which 46 underwent full-text review, and 19 met the inclusion criteria. Studies described interventions in radiation oncology (15 articles), medical oncology (3), and general oncology (1) settings in either North America (15) or Europe (4). The most common experimental designs were interrupted time series (10) or before-and-after comparisons (6), and were of either moderate (89%) or severe (11%) risk of bias. Interventions varied but could be broadly categorized as incident learning systems (8), quality improvement programs (7), provider education programs (2), a provider scheduling system (1), and a patient safety champion intervention (1). While 89% of studies reported improvement in safety culture, there was substantial heterogeneity in evaluated outcomes. Most assessed provider outcomes such as number of reported adverse events (11) or Agency for Healthcare Research and Quality Safety Culture survey results (7). Conclusions: Despite a growing evidence base to identify interventions to promote safety culture in cancer care, definitive recommendations were difficult to make due to heterogeneity in study designs and outcomes. Given the importance of safety culture in cancer care, additional high-quality studies and standardization of outcome measures are needed.

Incorporating Human Factors Analysis and Classification System (HFACS) Into Analysis of Reported Near Misses and Incidents in Radiation Oncology

PurposeHuman factors analysis and classification system (HFACS) is a framework for investigation into causation of human errors. We herein assess whether radiation oncology professionals, with brief training, can conduct HFACS on reported near misses or safety incidents (NMSIs) in a reliable (eg, with a high level of agreement) and practical (eg, timely and with user satisfaction) manner. Methods and MaterialsWe adapted a classical HFACS framework by selecting and modifying main headings, subheadings, and nano-codes that were most likely to apply to radiation oncology settings. The final modified HFACS included 3 main headings, 8 subheadings, and 20 nano-codes. The modified HFACS was first tested in a simulated trial on 8 NMSI and was analyzed by 5 to 10 radiation oncology professionals, with 2 endpoints: (1) agreement among participants at the main-heading, subheading, and nano-code level, and (2) time to complete the analysis. We then performed a prospective trial integrating this approach into a weekly NMSI review meeting, with 10 NMSIs analyzed by 8 to 13 radiation oncology professionals with the same endpoints, while also collecting survey data on participants’ satisfaction. ResultsIn the simulated trial, agreement among participants was 85% on the main headings, 73% on the subheadings, and 70% on the nano-codes. Participants needed, on average, 16.4 minutes (standard deviation, 5.7 minutes) to complete an analysis. In the prospective trial, agreement between participants was 81% on the main headings, 75% on the subheadings, and 74% on the nano-codes. Participants needed, on average, 8.3 minutes (standard deviation, 4.7 minutes) to complete an analysis. The average satisfaction with the proposed HFACS approach was 3.9 (standard deviation 1.0) on a scale from 1 to 5. ConclusionsThis study demonstrates that, after relatively brief training, radiation oncology professionals were able to perform HFACS analysis in a reliable and timely manner and with a relatively high level of satisfaction.